Performs professional nursing duties of a specialized nature in the care of patients requiring the most recent advances in general, intravenous, and regional anesthesia for surgical operations, respiratory care, cardiopulmonary resuscitation, pain management and/or fluid therapy, medical procedures, and obstetric services, within the clinical areas of the main operating room (OR), labor and delivery, pre-operative clinic, recovery room, and anesthetic procedures out of the OR (including, but not limited to endoscopy, interventional cardiovascular suite, lithotripsy center, pediatric radiology and emergency room). Duties involve administration of anesthetic agents and supportive treatment of patients undergoing surgery or other medical procedures. Maintains responsibility for determining the optimal type and method of anesthesia care to administer, for a broad range of surgical procedures, including the most complex performed at the Medical Treatment Facility (MTF). Scope of practice includes, but is not limited to, direct patient care; patient and staff education; research, consultation and referral, with physician and therapeutic interventions, as needed. 1. Anesthesiology Technology and Research. Applies a mastery of nursing to the latest developments in the rapid and continuing advancement of the anesthesiology field. Incorporates research, best practices, and leading edge technology in the treatment of diverse and highly complex patient care, facilitating policy and program changes in the delivery of professional anesthesia services. Applies new pharmacologic advances, with significant emphasis on drug safety, shorter durations of action, reversibility, and ease of administration. Adapts treatment to new theories in the focus of patient care, from inpatient to outpatient settings, as well as from available risk management data, and research on the development of new drugs regimens. Maintains abreast of, and participates in, evolving and continuing research; incorporates new and approved drugs into the practice of anesthesia, with emphasis on promoting rapid uptake, low toxicity, intense analgesia, easy reversibility, shorter durations, and fewer side effects. Applies and adapts new theories and developments, designed to facilitate agents of sedation, analgesia and sleep along with improved patient monitoring systems. Supports, participates in, and promotes ongoing research and publication of findings, for expansion and enhancement of the advanced practice role and latest initiatives in anesthesiology technologies. Initiates and/or participates in the design, implementation, monitoring, and evaluation of clinical research. Disseminates clinical practice and research findings through education and publication. 2. Direct Patient Care/Anesthesia Delivery. a. Provides anesthesia and related services in accordance with hospital regulatory, licensing and credentialing policies, and with American Association of Nurse Anesthetists (AANA) Guidelines for Nurse Anesthesia Practice and Code of Ethics. Complies with current standards of anesthesia practice and care. Conducts and participates in educational programs that improve anesthesia nursing practice. Provides anesthesia care that is within the scope of practice as determined by demonstrated competency, licensure and clinical privileges delineated by the MTF. b. Demonstrates competency in pre-anesthesia preparation; anesthesia induction, maintenance, and emergence; conscious sedation; pain management; post anesthesia care; peri-anesthetic and clinical support functions. c. Systematically collects data through interviews, observation, physical examination, and review of medical records, prior to scheduled surgery. Evaluates data, with respect to individualized anesthetic options and current recommended practices within the field, to determine and discuss the optimal type of anesthesia to be used, and to explain expected outcomes and possible anesthetic complications. Evaluates information and makes professional assessment to prescribe the anesthetic plan, utilizing new and evolving pharmacologic technologies, as appropriate. Consults with anesthesiologist or surgeon, as necessary, on desired course of action or anesthetic plan. d. Determines necessity for laboratory studies, coordinates ordering of laboratory tests and evaluates results. Interprets and reports abnormal diagnostic data and changes in signs and symptoms; modifies anesthetic plan accordingly. Identifies situations and conditions in which medical consultation, or surgical consultation, should be performed immediately. Documents assessments, orders, and interventions, appropriately, in the medical record. e. Administers anesthetic by inhalation, endotracheal intubation, regional, intravenous, or topical. Incorporates new and approved drugs into the practice of anesthesia, with emphasis on promoting rapid uptake, low toxicity, intense analgesia, easy reversibility, shorter durations, and fewer side effects. Induces anesthesia to safe, appropriate levels, and manages patient care throughout the surgical procedure. Monitors patient's loss of fluids; determines need for, and administers parenteral fluids, including plasma, blood, and other blood products; sets up solutions and maintains proper flow. Administers vasoactive pharmacologic agents, as needed, to maintain and augment a balanced, safe anesthetic. f. Observes the patient during the surgery, to accomplish and maintain the proper level of anesthesia depth and to prevent over-dosage. Adjusts the administration of anesthetic agents, as well as other drugs, and utilizes proper methods to support respiratory and circulatory functions of patients. g. Maintains responsibility for all techniques, drugs, and equipment used in the administration of anesthesia to patients undergoing any, and all forms of, surgical and/or diagnostic procedures. Sets up equipment used in performance of work, and maintains responsibility for the care, sanitation, inspection, and proper functioning. Enforces rules of safety, with respect to highly explosive anesthetics and gases; ensures that patients, personnel, and equipment are properly grounded, and that area is scavenged of waste gas anesthetics. h. Provides immediate, post-operative care to patients during their return to the intensive care unit or recovery room, to ensure clear patient airway, stable vital signs, hemodynamic stability, adequate pain control and avoidance of adverse reactions from anesthesia. i. Provides a full range of emergency services, including life-saving procedures, to resuscitate and stabilize patients, within the scope of practice and approved guidelines. Responds decisively to life-threatening changes in patient condition, providing immediate and appropriate emergency measures. Discriminates between normal and abnormal findings, to recognize various disease entities and problems, requiring consultation or referral to a higher level care facility. j. Participates in the development of peer audit processes, involving a systematic review of anesthesia records, to ensure the standard of care is met. Participates in review of the broader types of patient care processes, to ensure procedures are in compliance with Joint Commission on Accreditation of Hospitals guidelines. 3. Administrative Services. a. Utilizes knowledge of QA/QI, infection control, patient and staff safety, and risk management, to ensure compliance with established standards. Maintains abreast of health care trends, to support positive results in quality care. Participates in departmental continuous improvement programs and processes, emphasizing the latest developments and trends in the anesthesiology field. Formulates and evaluates clinical care standards and treatment programs for effectiveness in meeting patient needs. Explores methods and processes to reduce resource consumption, ensuring the patient receives quality care at the most appropriate level. b. Serves as a resource consultant to a wide variety of professional health colleagues, regarding the latest advances in nurse anesthesia and nursing practice. Provides consultation to other CRNAs as well as oversight and instruction to, students, residents, interns, and ancillary workers in the field of anesthesia, in both clinical and administrative areas. Provides feedback/evaluations (verbal and written) to the student and appropriate school/residency program. Plans and sets up programs for weekly staff meetings; arranges for guest and consultant speakers for educational programs. Delivers in-services and educational lectures, workshops, and case studies for the purpose of providing knowledge, skill, and introduce the latest initiatives in the evolving anesthesiology field, to other CRNAs, anesthesiology staff, nurses, and health care professionals/ paraprofessionals. Participates in the Department of Defense (DoD). Outcomes Management Initiative, to improve long-term and continuing health care outcomes of the population of patients served. PERFORMS OTHER DUTIES AS ASSIGNED.